Laserfiche WebLink
---- <br /> \ SAN JOACU)IN COUNT PUBLIC HEALTH SERVICES - ENVIRONMENIAL HEALTH DIVSION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE YORKSOFFT <br /> CILITY SITE NAME FFACILITY CONTACT NAME <br /> L7-IC_!- ( G LII\i lIE FACILITY ADDRESS tE PHONE 0 [!ith AREA CODE <br /> Al <br /> CITY STATE 21P C(x)E of TANKS --_ - - - --- <br /> S (�N (a/,\ n n[ SPIE <br /> P <br /> P APPLICANT/11II IND HANE APPLICANT PPLICAIIT [nN!nCT NAME <br /> F F_� VI A1C:, l'`I—� -I� <br /> C MAILING ADDRESS APPLICANT PHONE 0 WITH AREA C")F <br /> M 2.7 -reffP E1-- <br /> i CITT /STATE /ZIP CODE TYPE of APPLICATION .� <br /> J Cr 1A (IJLC.�• - (Closure, Instolintion, etc.)lel`-I��_1�1nL <br /> TOTAL <br /> T 1986 1987 1988 1989 1990 <br /> ANNUAL FACILITY FEE (Prior to January 1, 1991) = 1100.00 -- - — <br /> A f <br /> C ---- - - - - -- -- -- <br /> T FACILITY PENALTY FEES ASSESSED (If Applicable) xXxX xXxx f <br /> I --- <br /> V TANK FEE a 550.00/TANK (Prior to January 1,1991) 1170/TANK (After Jnnunry 1, 1991) <br /> E — <br /> 0 Tanks a 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> F (multiply 1by fee for -- <br /> A each year applleeble) S <br /> I TANK PENALTY FEES ASSESSED Xxxx XXXX f <br /> L --- <br /> I STATE SURCHARGE a 156.00 each TANK (Due every 5 years) See California H R S Cafe, Section 25287 <br /> T -- <br /> Y R Tanks x 556.00 1986 through 1990 1991 through 1996 <br /> (Enterengt—t and year) --- -- -- <br /> C PERMANENT CLOSURE (Removal or Authorited Closure-in-Place) TANK I.D. f(s) — <br /> L ---- <br /> 0 CLOSURE FEE a 178.00/hour 0 hours minimus/TANK) 0 TANK(s)�_ X 1234.00 <br /> U TEMPORARY CLOSURE (Plan Review S Inspections) TANK t.D. <br /> IT IE TEMPORARY CLOSURE FEE s 578.00/hour (3 hours minfmm/TANK) 0 TANK(s) X 1234.00 S <br /> P INSTALLATION PLAN CHECK (Plan Review R Construction Inspections) TANK I D. p(s) _ <br /> L — <br /> A <br /> N PLAN CHECK FEE a 578.00/hour (8 hours minlmm/FACILt TY) ^SA?4.00 minim m <br /> R REPAIR FEE (Workplan Review R Construction Inspections) TANK I.D. 0(s)___ ___ <br /> E ---- <br /> P TANK LINING REPAIR FEE a 178.00/hour (3 hours minimm/iANK) N TNIr,(s) _ x t234.00 S <br /> - -- <br /> A -- --------------- --- ------ ----- <br /> I TANK RETROFIT REPAIR FEE a 178.00/hour (3 hours min./FACILITY) = 57.34.00 minissen f <br /> PIPING REPAIR FEE a 178.00/hour 0 hours minimm/FACILITY) 5234.00 minim+n t <br /> N TRANSFER FEE a 120.00 UNAUTHORIZED RELEASE EVALUATION = 178.00/hr t <br /> S -- <br /> C CONSULTATION FEE a 178.00/hr SAMPLING INSPECTION FEE _ %78.00/hr S <br /> TOTAL DUE <br /> FOR OFFICE USE ONLY <br /> nmm nmvnremm!mmr!n!mn!!n!e!uma!amn:e!n! e!:r!!!;!=.!!n:r::u:!n!mnm!v!!'!c!rnanu!m!!mn!n!m;;:!rm:ewn!: .m!nnnnrm!M <br /> r nu nnenn reran n r �ia�um;rirnn'en�iunnn nm wnn.mwnnun n"rmnnm e r . :!. r.n:n�d n. n nt nr.r.rummi nnnnr.umrir.n;nn a:r ..!;n"nnra'ro, <br /> SWEEPS / COMPUTER / LOC CODE DIST CODE AMOUNT RECEIVED CHECK p/CASH RECEIVED BY DATE RECEIVED <br /> a <br /> 1 2 <br /> L I r ie <br /> mm!sn [m!m!mnm:::: vnm'!m!.: :mm:!am!!!:::::::m: !�::...:m-nnT!! •(n�!.. _ _ .. <br /> .mr:'re�i maemeee�a mmammar::mnm nm'rnTr'rmm�num!�.ud,rn;meu:u,; unin;en r n. ;:u_!:ai.0 n: nrnncnanenn <br /> EN 23 032 (REVISED 11.1-92) Pnge 11 <br />